Unhealthy Housing: Cost to the NHS

Jim Shannon Excerpts

Tuesday 26th February 2019 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the cost of unhealthy housing to the NHS.

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank right hon. and hon. Members for attending the debate, particularly the Scottish National party spokesperson, the hon. Member for Linlithgow and East Falkirk (Martyn Day); the shadow Minister, the hon. Member for Great Grimsby (Melanie Onn); and the Minister. I look forward to positive contributions from all those able to participate.

I am grateful to have been allocated the debate. As chair of the all-party parliamentary group for healthy homes and buildings, I am delighted to have the opportunity to raise awareness and concerns about the cost of unhealthy homes to the NHS. I thank the background staff, who are in the Gallery, who have given information to us all, myself in particular, to help us in the debate.

Our APPG was created to shed light on the many problems caused to our nation’s health, wellbeing and economy as a result of people living and working in unhealthy homes and buildings. Given that most of us spend some 90% of our time indoors, it stands to reason that our homes need to contribute positively to our physical and mental health and wellbeing, not diminish it. This debate is so important because it pulls together the critical issues. It is perhaps not a normal Westminster Hall debate, but it pushes very much to the fore the effect of the homes that we live in on our health and, ultimately, on the NHS.

The APPG, following a weight of written and oral evidence received, launched a report, “Building our Future: Laying the Foundations for Healthy Homes and Buildings”, in October last year. It was a well addressed report, to which there were many contributions, and it brought together those with a deep interest in homes and those with a deep interest in health issues. It is good to have the report finished.

I have given the Minister a copy of the report, which contains a series of excellent recommendations that are helpful to the Government and will help us to move forward. I hope the debate will be a turning point, and that those recommendations will lay the foundations for change. The report sets out what needs to be done to ensure that new and existing homes do not cause or exacerbate health problems, because they often do. Many of us here, as elected representatives, will have people coming to us every week to complain about their home and, more often than not, the health problems related to that.

This debate is long overdue. It is time to raise awareness of the extent of the problem, and to recognise the human cost to the United Kingdom of Great Britain and Northern Ireland of doing nothing. It is clear from the White Paper that unhealthy homes cost the economy and our society each and every year. Living in or occupying unhealthy homes directly and negatively impacts on human health. Unhealthy homes that lack daylight, or are cold, damp, poorly insulated, energy inefficient, overcrowded, noisy, badly designed and generate poor indoor air quality can, in the extreme, lead to unnecessary deaths.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

The hon. Gentleman is an old friend of mine. I think he knows that those of us who campaign on carbon monoxide poisoning really welcomed his excellent report. I have lost three constituents to carbon monoxide poisoning, which is one symptom of an unhealthy home. I assure him that we will work closely with him to ensure that no more people die of carbon monoxide poisoning.

[Jim Shannon]

The hon. Gentleman is absolutely right. My hon. Friend the Member for East Londonderry (Mr Campbell), who is sat to my left, also had constituents who passed away a few years ago due to carbon monoxide poisoning. That was in a holiday home, but it was none the less a problem. We in the APPG will take the comments of the hon. Member for Huddersfield (Mr Sheerman) on board, and we look forward to working with him.

Let me detail some of my concerns arising from the evidence that we heard. The effects of poor housing are estimated to cost the NHS £2.5 billion per annum; that rises when we consider all housing throughout the United Kingdom of Great Britain and Northern Ireland. The true cost lies in human misery and lives lost. Some of the figures are quite extreme, but they underline the issue. Some 43,900 excess winter deaths occurred in England and Wales in the winter of 2014-15, with cold homes causing one fifth of those. That is more than the number of deaths caused by road accidents, alcohol or drug abuse, which puts into perspective the need to make sure that homes are healthy. Children in cold homes are more than two times more likely to suffer from a respiratory problem. Cold homes increase the incidence of cold and flu, and worsen conditions such as arthritis and rheumatism. Again, we see that every day in our constituencies.

One in four adolescents living in a cold home is at risk of multiple mental health problems, so we are not always talking about physical issues; there can be emotional and mental issues as well. Those in poor-quality homes that lack effective ventilation suffer from indoor air pollution, which has been linked to allergies, asthma, lung cancer, chronic obstructive pulmonary disease, cardiovascular disease and, more recently, dementia.

[Andy Slaughter (Hammersmith) (Lab)]

I congratulate the hon. Gentleman on securing the debate and on championing this cause. I apologise: I will not be here for the whole debate. I am double-booked. There have been steps forward on this issue, such as the Homes (Fitness for Human Habitation) Act 2018, which was recently taken through Parliament by my hon. Friend the Member for Westminster North (Ms Buck). However, are conditions not getting worse for a lot of people? My experience is that there are two principal causes—the failure to build social housing, and the benefit cap—that force people into substandard accommodation in the private rented sector. Given the hon. Gentleman’s party’s special influence over the Government, could he persuade them to change those two egregious policies, which cause so much human misery?

[Jim Shannon]

If only we had that power! That is not to take away from the importance of the issue of social housing, which I will touch on later. Let us be honest: many people go into the housing that their pockets allow. As a result, they end up in housing that is not particularly in the right category, the right condition or the right shape. The hon. Gentleman is right that the benefit cap also dictates where someone can go. I will give the Minister plenty of time to get her thoughts together on that. However, that is an important point, and I will touch on it later.

Poor indoor air quality has an annual cost to the UK of more than 204,000 healthy life years. It causes thousands of deaths per year, and gives rise to health costs in the order of tens of millions of pounds. One third of people in the United Kingdom suffer from mould in their homes and are at increased risk of respiratory problems, infections, allergies and asthma. Just last week, I saw three constituents with mould growth issues in their houses—mould not caused by condensation, but ingrained in the walls. Sometimes ensuring that the housing associations or housing executive take those issues on board is quite a job.

There are more than half a million overcrowded households. The issue affects one in 10 children—something we cannot ignore. Overcrowding is linked to health and development issues, including meningitis, respiratory conditions, slow growth rates, accidents in the home, stress, anxiety, depression and poor adult health. Occupants of poor-quality housing are more likely to suffer from restricted daylight and noise pollution.

We cannot ignore noise pollution. In the news this morning someone put forward the idea of building houses and flats over railway lines. I am not sure if any hon. Member saw that. The first thing that came to my mind was the noise of the trains continually going underneath. How could those homes be adapted to mitigate that? We need to address noise pollution. Natural light helps to improve the recovery times of long-stay patients and reduces anxiety and the need for medication. Noise pollution can cause long-term health issues and increase stress and the risk of cardiovascular effects.

It is clear that there is a lack of public awareness of these problems, and limited knowledge of the facts. Too often, the homes we live in are, in so many ways, causing or aggravating health problems.

[Mr Sheerman]

The hon. Gentleman is making a very good speech, and I am nervous about intervening again, but will he accept this point? He talks about the noise pollution from living over a railway, and we know that private rented accommodation is a real problem. On the other side of the equation, very modern and expensive housing that is totally hermetically sealed could be as dangerous, because it traps all the gases and pollutants within the home—not only carbon monoxide, but many other emissions.

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[Mr Laurence Robertson (in the Chair)]

I would not want to miss anything that the hon. Gentleman said; that is the point.

[Jim Shannon]

I thank the hon. Member for Huddersfield for intervening again. It is always good to have him adding his words of wisdom to any debate, at any time, in this Chamber or in the main Chamber. The issue is clear: too often, the homes that we live in are, in many ways, causing or aggravating health problems. That cannot be ignored. Given the plethora of health issues that I have identified as caused by unhealthy homes, and given the cost to the NHS, it is time to ask who in Government is responsible and accountable. We look to the Minister for answers.

[David Simpson (Upper Bann) (DUP)]

One issue that has been raised with me in Northern Ireland—I am sure that it affects the whole United Kingdom—is that when it comes to old and listed buildings, and particularly rows of listed houses, it is sometimes very difficult to get adaptations done, because they have to be done in a certain way.

[Jim Shannon]

My hon. Friend highlights one of the kernels of the debate. Our white paper calls on the Government to take a holistic approach to future housing and ensuring that people’s health and wellbeing is placed at the heart of the built environment. That is clearly what my hon. Friend is saying, and that is where we are. Our white paper states that there must be effective leadership, and recommends that there be one Department responsible for healthy homes and buildings to ensure, critically, that homes and buildings maintain the highest standards for health and wellbeing; to identify where homes and building are causing health issues; to measure the economic and social benefits of healthier homes and buildings; to reduce health inequalities, of which there are many across the postcodes of the United Kingdom; and to provide for a common definition and approach to policy, regulation and standards. That makes complete sense to me.

Furthermore, an interdepartmental Government committee involving all Departments and agencies responsible for health, housing and construction—including the Department of Health and Social Care, the Department for Education, the Ministry of Housing, Communities and Local Government, and Public Health England—should be formed to ensure that health and wellbeing is placed at the heart of existing and future housing provision.

If we are to build houses, let us build them right. Let us ensure that the issues to which the hon. Member for Huddersfield referred do not arise, whether the homes are very expensive or of a lesser quality. I have serious concerns about the standards and quality of new housing inadvertently being driven downwards, without consideration of the cost to human health. In the context of the Government’s very healthy ambition to build 300,000 new homes and their healthy new towns initiative, standards must be driven upwards. It is essential that the Government adopt a holistic approach to delivery that addresses safety, space, energy efficiency, ventilation, heating, noise, air quality and lighting. We must all want to see quality new homes and communities being built with health and wellbeing in mind. I hope that the Government will agree that maximising the occupants’ health and wellbeing must be placed at the centre of new housing provision and building design.

Of course, we live in homes that have already been built, most of us in the privately owned or privately rented sector, to which the hon. Member for Huddersfield referred. Renovation of existing housing stock must also become a Government priority. This is not just about building new homes, but about ensuring that the homes that we already have are up to standard. Our white paper calls on the Government to develop plans to retrofit existing homes to maximise health and wellbeing and improve health performance.

Today, I have set out the problems caused by unhealthy homes and buildings. I now call on the Government to take on board the recommendations in the APPG for healthy homes and buildings white paper, which are as follows. There needs to be greater public awareness of the health problems exacerbated by unhealthy homes, and the health benefits to be gained through simple improvements and behavioural change. Importantly, how we live in the homes we build becomes part of where we are. In building new homes, priority must be given to ensuring that people’s health and wellbeing is foremost, specifically at the planning stage and through the national planning policy framework. Again, we look to the Minister for responses on these issues.

The Government need to commit to building greater numbers of quality social and affordable homes to help to alleviate issues of overcrowding and poor physical and mental health, which are all part of this. The Government need to optimise the health performance of new and existing homes, and ensure that they are built or retrofitted to “full health”. There must be greater focus on enforcement and quality control of home renovation standards, so there is a role for councils to play when it comes to checking the work that is done and ensuring that it is done to an acceptable standard.

The Government must commit to building the evidence base and promoting the link between housing and health and wellbeing. That would result in considerable savings to healthcare costs, increased educational attainment, improved productivity, and people leading longer, healthier and happier lives. The exact cost of unhealthy housing to the public purse, and the human cost, in terms of health and wellbeing, educational attainment and social care, is unfathomable. To date, Government attention to and policy thinking about this problem have been—I say this respectfully—woefully absent. We ask the Minister to address the issue in her response. We are looking for constructive comments. That is what I am about—indeed, what we are all about in the House—but we do need answers on what we are putting forward.

Ultimately, the recommendations made in the white paper provide the basis for a step change in policy, which will drive up standards and help to reduce the health problems caused or made worse by living and working in unhealthy homes and buildings. That is the purpose of this debate: to consider how we can do this together, and better, across the whole United Kingdom. The white paper is testament to the need to build better quality homes and buildings, as well as to upgrade existing housing stock, which comprises the vast majority of the homes that people live in today. We need to do something with new homes and set the standards, and then we will have to do something with the homes that we already have to bring them up to the standard necessary.

It is beyond doubt that there is a problem that needs urgent action. There is a lot to be gained by building and retrofitting homes to the highest quality and standard to achieve health and wellbeing. These are the pluses: lower costs to the NHS and a healthier population; better finances; better educational attainment and workplace productivity; reduced emissions—the hon. Member for Huddersfield referred to carbon monoxide—lower energy bills and a lower carbon footprint; improved health, wellbeing and comfort; and greater life chances and independent living and care.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate my hon. Friend on securing the debate, and on the work that he continues to do on these issues. Does he agree that the subject that he is entering into—the need to renovate and upgrade housing stock—is particularly applicable in lower socioeconomic areas, in both Northern Ireland and, I am sure, across the UK? In those areas, health issues are even more prevalent than in the rest of society, so his point about the benefit to the NHS is even more applicable with regard to those socioeconomic groups.

[Jim Shannon]

My hon. Friend is absolutely right. Those are the cases that we deal with in our constituency offices each and every day. Those issues are the subject of the site meetings that we have with the executives of housing associations, and of the meetings that take place with councils’ environmental health departments, back home and over here. There is a greater impact on those at a certain socioeconomic level, as the hon. Member for Hammersmith (Andy Slaughter) also said. Benefits also come into the process; there is the question of what people can afford to purchase and deal with.

I call on parliamentary colleagues from across the House to join me in taking forward the recommendations in the white paper, and call on the Government to join together and provide the necessary leadership and focus. We look to the Minister to do those things. The cost-benefit and rewards could be significant. The economic burden and sheer human misery created by poor homes and buildings, to which other hon. Members have referred, are simply too great to ignore.

I thank all right hon. and hon. Members for being here, and thank those Members who have come along to make a contribution. It is so important for us to deal with this issue. We look to the Minister for a significant and positive response—no pressure, but we do think it is important that we air these issues.

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[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve with you in the Chair this morning, Mr Robertson.

I start by thanking the all-party parliamentary group for healthy homes and buildings for its report, which is excellent and so needed in the light of the serious housing situation in many of our constituencies. Consequently, I am delighted that the Under-Secretary of State for Housing, Communities and Local Government, the hon. Member for South Derbyshire (Mrs Wheeler), is here in Westminster Hall today. I had wondered whether a Health Minister would respond to this debate, but it is really important to get to the root of these problems. We hear that £2.5 billion is the cost of unhealthy housing, which I think is a very modest estimate. If we could shift that money into building and retrofitting homes into a better condition, what a better society we would have.

Of course, I look back to Michael Marmot and the report he produced when he looked at the social determinants of poor health and identified housing within them. The report by Dame Carol Black also emphasised the impact of poor housing. And, of course, we know from living experience the impact of poor housing on our constituents today.

So this is a timely debate and an important debate. We must look not only at physical health. We have heard about respiratory conditions; as a former physiotherapist who worked in that area, I certainly know the impact that poor housing had on my patients. However, we must also look at mental health, which is also incredibly important; I see that every week in my constituency.

We also know that there is the wider issue of affordability, and the stresses and strains that the failed housing market places on our constituents. In York, buying a property now costs ten times the average wage and therefore it is becoming completely inaccessible. People are having to up sticks and make a choice about their career or their living environment. Renting is also completely inaccessible in the private rented sector, and in the social rented sector the amount of stock has been reduced and therefore people’s options are also being reduced.

The quality of housing is also a massive issue. In York, 200 houses have a water course running under them—under the floorboards. As a result, there is damp, particularly at this time of year, which really impacts on the families in those houses. The council has a programme for those houses, but it is taking too long to move people out of their homes and make the changes that are required, which almost amounts to rebuilding the underneath of the property so that residents can move back in. So the quality of housing is a serious issue, including in York.

We have also heard about fuel poverty. I think we are all absolutely stunned into silence when we hear that 51,000 people in our country died prematurely last winter, with 46,000 of them being older people who were unable to afford to flick the switch and put their heating on. Those are unnecessary deaths and it deeply concerns me that we have not redressed this issue; it is essential that the Government put a real focus on it.

I will talk about one or two cases in my constituency that have completely appalled me. I have already shared the information about some of them with the Minister, and they have to do with the behaviour and the conduct of my local authority.

People will remember that a few weeks ago it was bitterly cold, with freezing fog. An 18-year-old woman in my constituency had not complied with all the obligations placed on her as a young person in housing; her complying with them was challenging, both for her and for the authority. Therefore, the authority removed her right to be in housing provision. Putting a young woman on to the streets is one thing; to do so in freezing conditions, when the temperature is minus 6° C, is another. So we really have to consider what was behind that decision. Thankfully, my office jumped in and secured that young woman a placement elsewhere, in the light of our holding up a mirror to that situation.

We also have to think about our homelessness services. I have spoken in many debates in this place about what has happened with homelessness. Again, dealing with homelessness is about the joining-up of services, to make sure, first of all, that Housing First is in place. I know that if Labour were in the administration in York, we would end homelessness within a term of being in charge of the council, because we believe that housing is a human right. We are a human rights city and we believe that it is a human right for people to be able to access a home. We know that not being able to access a home has a serious impact on people, including on their physical health. We know that 41% of the homeless population have serious physical health conditions and 45% have serious mental health conditions. However, there is also the tie-in with substance misuse and other issues that have a serious impact.

The case that perhaps shocked me the most was that of a woman whose partner had moved out of their home, for certain reasons. Initially she was left in the property, but because of the change in the tenancy she was then forced out of her property. A relationship breakdown is stressful enough for somebody, but being told that they have to leave their property because a tenancy—an arrangement—has changed, and having to move into another property, was incredibly stressful for my constituent. She became seriously ill: she lost two stone in weight; she developed anxiety and depression; and she became extremely ill. In fact, she could hardly speak, because the stress on her was so great that she could hardly talk. Her mental health was in a very poor place, and yet the council pursued her and continued to move her from her property. She lost her business, she lost her work and she ended up on benefits, and was finally forced to move over the Christmas period.

That kind of behaviour by our local authority is contemptible, and I say to the Minister today that we must have mechanisms by which we can put the impact of housing policy and housing policy decisions, not only on people’s physical health but on their mental health too, at the heart of decision making, because that situation with my constituent should never have arisen. As soon as she started becoming ill, the council should have started to pull back, but it did not.

I have seen that with another tragic case in my constituency. A young man has support needs. He had been living with his parents, but sadly one of his parents died and then the other. However, the Government policy about successor rights for property meant that this young man, whose home was his place of safety, was turfed out of his home and then placed in hostel accommodation. In that accommodation he lost his security, his surroundings and the neighbours who had kept an eye on him, and he ended up walking the streets during the day. He found that incredibly difficult. He was dealing with the double trauma of losing his parents and then his home. We need to put compassion back into housing policy, because not doing so makes people ill.

[Jim Shannon]

I thank the hon. Lady for her significant contribution. She has reminded me that in my office we have had three cases of homeless people over the past month, and the last one she referred to is very much in my mind. We seem to have people who slip under the microscope, with complex issues regarding health and losing their homes, contacts and friends. As the hon. Lady said, we need a better way of dealing with those issues. One way to ensure that those people do not fall under the radar would be to mark up any early-recognised physical or mental issues as a priority for the officer.

[Rachael Maskell]

The hon. Gentleman is absolutely right. A home is not just a physical structure of bricks and mortar; it is a whole environment in which someone lives and probably spends most of their time, whether asleep or awake. It is a security, a setting, and a place where the family is based, and it affects someone’s wellbeing.

We must take a more humane approach to housing, and York, as a human rights city, is determined to see that. Housing is a major issue in the city; we have a massive supply problem. Every time the Government say they are building more homes, I say, “But not in York”. Our council has completely failed on that front, and it now looks like the local plan, which has been prevaricated over, is in real danger of falling because sites are pulling away. We have overcrowding because we do not have the housing supply we need, which means we have families who have been living on sofas for months on end. I received a letter just this last week about a gentleman who is not well and has been sleeping on the sofa for three months. The council has not intervened in that kind of case. It is right that we get a local plan to build the housing the city needs to address future accommodation needs—not all those luxury apartments we see going up everywhere.

My final point concerns my role as chair of the all-party parliamentary group for ageing and older people, and the provision we are making for our older people, ensuring that we have the right environments for them to live in. Increasingly, older people live in the private rental sector, which provides insecurity in later life. Others in the sector also face that insecurity, but it is compounded in the later stages of life. It is really important to build secure housing for older people.

We know that isolation and loneliness have a massive impact on wellbeing, but it is also about the place and the environment in which people live. I urge the Minister to look at some of the impressive projects in the Netherlands, building villages that are safe environments for older people. In Hogeweyk, a dementia village, people have their independence, which keeps them on their feet, which then keeps them healthy, and they can move safely around a village environment while at the same time having a few people keeping an eye on them. Three or four people, at various stages of dementia, live in each house. There is a shop and a hairdressers on the complex, and other places that people can go, but it is a closed environment that keeps people safe. There are some good models out there of how we can build proper homes for life and ensure that people do not have the stress—we all know that moving home is stressful—of having to move at a fragile point in their life.

There is so much more we can do with this agenda if a real aspiration is there to change how we look at the complex dual issue of health and housing. Should Labour come into power in York in May, our plans are to build transformation, ensuring both that we have private rental sector licensing to drive up standards, and that we build the homes that people need in a healthy environment, place making as we go, so that everyone can enjoy the place where they live.

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[Jim Shannon]

I thank everyone for their valuable contributions. As the Minister said, it has been a constructive debate. Everyone who contributed, whether with a speech or an intervention, added important information.

The hon. Member for St Ives (Derek Thomas) referred to removing people from fuel poverty, winter deaths, delivering social care, and how children learn better in warm homes. My hon. Friends the Members for East Londonderry (Mr Campbell) and for Upper Bann (David Simpson), and the hon. Member for Hammersmith (Andy Slaughter), focused in their interventions on social housing and socioeconomic issues. Health and housing cannot be divorced, as the debate has reinforced.

The hon. Member for Coventry North East (Colleen Fletcher) referred to how house deterioration makes people physically and mentally ill, and to the issue of rogue landlords, which the Minister also mentioned. Tenants are at their wits’ end. The hon. Member for York Central (Rachael Maskell) referred to 200 homes with water rising under the floorboards. She is clearly in touch with her constituents when it comes to raising the standard and condition of older homes. She referred to the APPG for ageing and older people, and security in later life, which is important.

The hon. Member for Huddersfield (Mr Sheerman) referred to carbon monoxide and cowboy builders. Old homes need to be upgraded, but social housing, private rented accommodation, student accommodation and smoke alarms are also all critical issues. The hon. Member for Linlithgow and East Falkirk (Martyn Day), the Scottish National party spokesperson, spoke of the debate’s importance, and how homes must be warm, dry and affordable. He gave us a Scottish perspective on the issues. Again, overcrowding, pressure and family relationships are so important. The shadow Minister, the hon. Member for Great Grimsby (Melanie Onn), described how many homes are not up to standard. She talked about low incomes, renting from disreputable landlords, health and infections in homes. Those issues are all important.

I thank the Minister for responding so well to all our contributions and questions. It is always a pleasure to be in her company, and it was a pleasure to hear her response to the points that we made on cold homes, healthy place-making, and safe, decent housing. She responded by showing her commitment to those issues. I am very pleased that she suggested a meeting. It is very clear to me that on safety regulations, she answered the questions regarding healthy homes and buildings.

I thank the secretariat of the APPG for healthy homes and buildings, who are in the Gallery, for their valuable contribution to making this happen, and to the white paper inquiry and its conclusions. We have all contributed to a very important debate on healthy homes and buildings and the NHS. There is so much more that we can do. Today we demonstrated to the Minister, singularly and collectively, that there is so much more that we can do. We are all committed, alongside the Minister, to ensuring that we deliver on that.

Again, I thank all Members for their contributions, and for being here on a Tuesday morning. It is such a pleasure to be here on a Tuesday morning, rather than at 3.30 on a Thursday afternoon.

Question put and agreed to.

Resolved,

That this House has considered the cost of unhealthy housing to the NHS.